FR901228 Alone or Combined With Rituximab and Fludarabine in Treating Patients With Relapsed or Refractory Low-Grade B-Cell Non-Hodgkin’s Lymphoma

Inclusion Criteria:

Patients must have histologically and clinically confirmed relapsed and/or refractory low grade follicular B cell NHL (follicular small cleaved cell, follicular mixed small and large cell, and small lymphocytic lymphoma (according to the IWF classification); the malignant tissues must be positive for CD 20 on immunohistochemistry or flow cytometry

History of one or multiple prior chemotherapy regimens for low grade follicular NHL, but no more than 4 therapies

For the phase II trial: previous therapies can include rituximab, fludarabine (alone not in combination or sequentially); the most recent therapy should be completed more then 4 weeks prior to protocol entry, 6 months if the last regimen included Fludarabine, rituximab, nitrosoureas or mitomycin, and at least 8 weeks out from a treatment with UCN-01
For phase I trial: Patients can move from phase II to phase I trial if they have not received rituximab and fludarabine in combination or sequentially in the past, if they received one or both agents individually and had a 50% responses; this response corresponds to PR to prior therapy
Presence of measurable disease by CT scan 4 weeks after the last chemotherapeutic regimen with at least one lesion greater than 1.5c m in one dimension and or positive bone marrow biopsy
ECOG performance status ≤ 2 with a minimal life expectancy of 4 months
Female patients of childbearing age should have negative pregnancy test; pregnant and breast-feeding women will not be eligible for the study because the antiproliferative effects of depsipeptide may be harmful to the developing fetus or nursing infants
Absolute neutrophil count >= 1000/µl; lower ANC (>= 500/µl) count will be considered if they are due to a bone marrow involvement by the disease; patients can receive growth factors (G-CSF and erythropoietin) to sustain the peripheral counts during the cycles of therapy
Platelets >= 100.000/µl; lower platelets (>50.000/µl) count will be considered if they are due to a bone marrow involvement by the disease; patients can receive growth factors (G-CSF and erythropoietin) to sustain the peripheral counts during the cycles of therapy
Total bilirubin =< 1.5 x institutional upper limit of normal
AST/ALT =< 3 x institutional upper limit of normal
Creatinine =< 1.5 x the institutional upper limit of normal
Patients with history of seizures are included if under adequate control; blood levels of seizure medications are monitored during the study
The patient must understand the investigational nature of the protocol, potential risks and benefits of the study and provides an informed written consent form

Exclusion Criteria:

Patients who have had chemotherapy or radiotherapy within 4 weeks (within 6 weeks for rituximab, nitrosoureas and mitomycin and within 8 weeks for UCN-01) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Patients who had prior treatment with depsipeptide or any other histone deacetylase inhibitor
Patients who had prior allogeneic stem cell transplantation
Bulky disease: single mass greater than or equal to 10 cm
Patients may not be receiving any other investigational agents
Patients with known CNS involvement (as documented by MRI and or cerebro-spinal fluid examination) should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurological dysfunction that would confound the evaluation of neurological and other adverse events
History of life threatening allergic reactions attributed to agents used in the study
Impaired cardiac function: history of life threatening arrhythmias, MI within the preceding 6 months, severe CAD, cardiomyopathy, congestive heart failure >= NYH II; EF =< 40%; EKG abnormality i.e.: ischemic ST-T abnormalities, QT prolongation, pathologic q waves, arrhythmias (except for benign PAC's and PVC's, 1st degree AV block, 2nd degree AV block Wenkebach); patients with LVH on EKG will be ineligible for this trial
Patients with prior malignancies other then basal cell carcinomas and cervical intra-epithelial neoplasia
Patients (or their partners) unwilling to use contraception
Patients who require pharmacological doses of corticosteroids for intercurrent medical conditions
Patients who uses concomitant drugs which may cause a prolongation of QTc